<form role="form" method="POST" id="contact-form" action="order.do?submitFreeOrderInfo"
	class="mobile-small-new-form" enctype="multipart/form-data">

	<div class="col-sm-12">
		<div class="form-group">
			<label for="edit-title-1">Name:</label><input type="text" id="m-Name"
				name="name" placeholder="Name" class="form-text form-control" />
		</div>
	</div>
	<div class="col-sm-6">
		<div class="form-group">
			<label for="edit-title-1">Phone:</label><input type="text"
				id="m-Phone" name="phone" placeholder="Phone"
				class="form-text form-control" />
		</div>
	</div>
	<div class="col-sm-6">
		<div class="form-group">
			<label for="edit-title-1">Email:</label><input type="text"
				id="m-Email" name="email" placeholder="Email"
				class="form-text form-control" />
		</div>
	</div>
	<div class="col-sm-6">
		<div class="form-group">
			<label for="Quantity">Quantity:</label><select id="Quantity"
				name="quantity" class="form-text form-control"><option
					value="30">10</option>
				<option value="31">20</option>
				<option value="32">50</option>
				<option value="33">100</option>
				<option value="34">200</option>
				<option value="35">300</option>
				<option value="36">500</option>
				<option value="37">1000</option>
				<option value="38">2000</option>
				<option value="39">3000</option>
				<option value="40">4000</option>
				<option value="41">5000</option>
				<option value="42">7500</option>
				<option value="43">10000</option></select>
		</div>
	</div>
	<input type="hidden" id="m-Deadline" name="form[Deadline]"
		placeholder="Deadline" class="form-text form-control" /><input
		type="hidden" value="1" name="Deadline" />
	<div class="col-sm-6">
		<div class="form-group">
			<label for="edit-title-1">AlternativeEmail</label><input type="text"
				id="m-AlternativeEmail" name="form[AlternativeEmail]"
				placeholder="AlternativeEmail" class="form-text form-control" />
		</div>
	</div>
	<script type="text/javascript">
									$('#m-AlternativeEmail').parent().parent()
											.addClass('TopTd');
								</script>

	<div class="clearfix"></div>

	<div class="col-md-12">

		<div class="clearfix"></div>

		<div class="center-submit">

			<input name="button"
				class="btn btn-warning submit-blue-form btn-lg btn-block"
				id="button" value="Give me your best price"  type="submit">

		</div>

	</div>

</form>